Buy Subscription – Humble Warrior Yoga

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Question	Yes	No
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?
In the past month, have you had chest pain when you were not performing any physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?
Do you know of any other reason why you should not engage in physical activity?
Have you been advised by a medical professional to increase or adapt your activity levels?
Have you ever had any injuries or chronic pain? (If yes please provide further detail below)
Have you ever undergone any surgeries? (If yes please provide further detail below)
Has a medical professional ever diagnosed you with a chronic disease, such as heart disease, hypertension, high cholesterol or diabetes? (If yes please provide further detail below)
Are you currently taking any medication? (If yes please provide further detail below)